J.Jpn. Surg. Soc.. 89(6): 889-897, 1988

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Original article

DIAGNOSTIC VALUE OF COMPUTED TOMOGRAPHY FOR INVASION TOWARD THE CAUDATE BILE DUCT BRANCH IN CARCINOMA OF THE HEPATIC HILUM

The visualization of the caudate bile duct branch (B₁) in computed tomography (CT-scan) with a high dose of contrast medium was evaluated in 71 patients with carcinoma of the liver, biliary tract and pancreas, preoperatively. The patients were classified into four groups: Group A, 22 patients (twelve hepatomas, six gall bladder cancers and four cancers of the pancreas body or tail) without abnormal findings in the biliary tract; Group B, two patients (cancer of the pancreas head and the common bile duct) with obstructive jaundice whose CT-scans were taken before percutaneous transhepatic cholangiodrainage (PTCD); Group C, 22 patients (16 cancers of the pancreas head and six common bile duct cancers) whose CT-scans were taken after release of jaundice by PTCD; Group D, 25 patients with carcinoma of the hepatic hilum whose CT-scans were taken after release of jaundice by PTCD. The results were as follows.
1) In Group A, B₁ was invisible in all the patients.
2) In Group B, B₁ was clearly visible in all the patients. But in Group C, B₁ was visible only in one patlent.
3) In Group D, B₁ was visible in 19 out of 25 patients and in 18 patients out of these 19 patients, cancer invasion toward B₁ was histopathologically confirmed. In contrast, invasion was revealed only in one out of six patients whose B₁s were invisible.
From these results, it is concluded that in carcinoma of the hepatic hilum the visualization of B₁ in CT-scan after release of jaundice by PTCD strongly suggests the cancer invasion on B₁, and requests the caudate lobe resection.

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